ORIGINAL - BY C, EVERETT Koo~,+lD, ScD SURGEON GENERAL OF THE U, S. PUBLIC HEALTH SERVICE U, S, DEPARTMENT OF HEALTH AND HUMAN SERVICES PRESENTED TO THE CENTER FOR POPULATION OPTIONS CAUCUS FOR PRODUCERS, WRITERS, AND DIRECTORS Los ANGELES, CALIFORNIA SEPTEMBER 18, 1987 1 (GREETING TO HOSTS, GUESTS,FRIENDS, ETC.) I'M DELIGHTED TO JOIN YOU TODAY AND TO SPEND A FEW MINUTES SHARING WITH YOU SOME OF OUR CONCERNS ABOUT AIDS. AND WHEN I SAY "OUR", I'M NOT USING THE ROYAL 'WE', I REALLY MEAN YOU AND I . . ..TOGETHER. I AM NOT HERE TO LECTURE YOU ON AIDS. I AM HERE TO ENLIST YOUR ASSISTANCE IN THE FIGHT AGAINST AIDS. FOR MANY OF OUR YOUNG PEOPLE THE ENTERTAINMENT INDUSTRY IS THE PRIMARY SEX EDUCATOR. YOUR STORIES AND CHARACTERS INFLUENCE THEIR SEXUAL ATTITUDES, VALUES AND BEHAVIOR. THE COUNTRY NEEDS YOUR ASSISTANCE, IiITHOUT IT i4E CANNGT UIN THE FIGHT AGAINST AIDS. I'VE BEEN LOOKING FORWARD TO THIS OPPORTUNITY, AS MARCY KELLY KNOhS. SHE'S BEEN VERY ATTENTIVE AND SENT ME ALL KINDS OF MATERIALS OVER THE PAST SEVERAL WEEKS TO HELP ME PREPARE FOR TODAY. 2 THE SHOWS I REVIEWED, "AN EARLY FROST", "AN ENEMY AMONG US" AND EPISODES OF L.A. LAW AND ST. ELSEWHERE CLEARLY DEMONSTRATE YOUR ABILITY TO PRESENT AIDS ISSUES IN AN INFORMING, MOVING AND SENSITIVE WAY. I WANT TO TALK SOME ABOUT THE EPIDEMIC OF AIDS--OR THE "PANDEMIC" OF AIDS, AS IT'S CALLED AT THE WORLD HEALTH ORGANIZATION. AND fiIDS IS, I'M SORRY TO SAY, A "WORLD CLASS" DISEASE. I WON'T DWELL VERY MUCH ON THE FACTS ABOUT AIDS BECAUSE--AND I'M ABSOLUTELY SERIOUS ABOUT THIS--THE TELEVISION INDUSTRY HAS DONE A SUPERB JOB GETTING THE BASIC FACTS OF AIDS OUT TO THE AMERICAN PEOPLE. THE ENTERTAINMENT INDUSTRY HAS EDUCATED WITH FACTS IN THE CONTEXT OF REAL LIFE SITUATIONS THAT POEPLE CAN RELATE TO. AND THAT HASN'T BEEN EASY TO DO, GIVEN THE SUBJECT...AND GIVEN THE USUAL BRIEF ATTENTION SPAN OF THE AMERICAN PEOPLE. YOU HAVE BEEN OUTSTANDING IN THE VARIETY OF APPROACHES AND FORMATS YOU USED TO DO THIS COMPLICATED JOB OF PUBLIC EDUCATION. 3 IN FACT, YOU'VE DONE SUCH A GOOD JOB, ALONG WITH YOUR COLLEAGUES IN THE PRINT MEDIA, THAT A GROUP OF RESEARCHERS AT COLUMBIA UNIVERSITY FOUND THAT--QUOTE-- "BETWEEN JUNE 1983 AND AUGUST 1986, THE PERCENTAGE OF THE POPULATION WHO SAID THAT THEY HAD HEARD OR READ ABOUT AIDS INCREASED FROM 77 PERCENT TO 99 PERCENT.' --CLOSED QUOTE. AND THEY GO ON TO SAY--QUOTE-- 'THERE ARE VIRTUALLY NO DIFFERENCES AMONG DEMOGRAPHIC CATEGORIES IN THE PERCENTAGE OF THOSE AWARE OF AIDS . ..MEDIA COVERAGE APPEARS TO HAVE OBLITERATED THE 'AWARENESS GAP' BETWEEN POPULATION SUBGRQUPS.'-- CLOSED QUOTE. THE RESEARCHERS LOOKED AT THE JOINT SURVEYS DONE BY A.B.C. AND THE NEW YORK DAIILY NEWS AND THE WASHINGTON POST, BY C.B.S. AND THE NEW YORK TIMES, AND BY N.B.C. AND THE WALL STREET JOURNAL, AS WELL /jS SURVEYS DONE BY ROPER, LOU HARRIS, GALLUP, AND OTHERS. AND WHILE I'M HERE IN ITS HOME CITY, r PERSONALLY WANT TO SINGLE OUT THE LOS ANGELES TIMES FOR ITS CONSISTENT AND ACCURATE COVERAGE OF THIS DIFFICULT TOPIC FOR THE PAST 6 YEARS. 4 AS A PLAIN CITIZEN, AS WELL AS YOUR SURGEON GENERAL, I VALUE WHAT YOU'VE DONE FOR POPULAR UNDERSTANDING OF THE DISEASE OF AIDS. BUT.."WHAT HAVE YOU DONE FOR US LATELY?" IN FACT, QUITE A BIT. WE'VE JUST HAD THE "NATIONAL TELEVISED AIDS AWARENESS TEST" AND NEXT MONTH, WHICH IS "NATIONAL AIDS AWARENESS MONTH':, ANOTHER SPECIAL PROGRAM, "AIDS: WHAT EVERY FAMILY NEEDS TO KNOW ABOUT IT", WILL BE CARRIED ALSO. ON THE ENTERTAINMENT SIDE YOU HAVE PRODUCED THE EXCELLENT SHOWS I MENTIONED EARLIER. ALL RIGHT, THEN. "WHAT CAN YOU DO FOR US NEXT?" FIRST, I AM PLEASED TO HAVE READ IN THE NEWSPAPERS THAT WRITERS AND PRODUCERS ARE TAKING THE SEXUAL CONTENT OF THEIR PROGRAMS INTO CONSIDERATION RELATIVE TO AIDS. I UNDERSTAND THAT MOVIE AND T.V. CHARACTERS WILL BE RESPONDING TO THE AIDS ISSUE. THEREFORE, IN. THE NEXT FEW MINUTES, I'M GOING TO TOUCH ON TWO ISSUES WITH YOU. . . ISSUES THAT WE SEE ONLY IN DIM OUTLINE IN THE DARKNESS AHEAD. BUT WE KNOW THEY'RE THERE. AND WE'RE CONCERNED. I HOPE YOU CAN BRING THESE ISSUES TO THE PUBLIC IN WAYS WHICH GOVERNMENT NEVER CAN. 5 THE FIRST ISSUE IS DIRECTLY RELATED TO THE PRIMARY WAY THAT AIDS HAS BEEN TRANSMITTED SO FAR. AND THAT'S BEEN THROUGH SEXUAL INTERCOURSE BETWEEN MEN... HOMOSEXUALS CR BISEXUAL MALES. TWO OF EVERY 3 C\IDS VICTIMS HAVE BEEN IN THIS CATEGORY. WE'VE ALSO RECENTLY LEARNED THAT AIDS IS TRANSMITTED AMONG HETEROSEXUALS AS WELL. THIS FACT HAS GRADUALLY EMERGED JUST WITHIN THE PAST YEAR OR SO, BUT IT'S MADE US GO BACK TO CUR DRAWING-BOARDS TO RE-FIGURE ALL OUR PROJECTIONS FOR THE SPREAD OF THIS DISEASE IN THE YEARS AHEAD. WE'VE ALSO HAD TO RE-THINK ALL OUR PLANS FOR PREVENTING THAT SPREAD FROM TAKING PLACE. AT THE TIME THAT AIDS SEEMED TO BE LIMITED TO THE HOMOSEXUAL COMMUNITY, WE WORKED WITH ITS LEADERS TO HELP SENSITIZE THOSE MEN TO THE NEED TO BE SEXUALLY RESPONSIBLE. FOR MANY MEN, THE MESSAGE ARRIVED TOO LATE...AND THEY ARE NOW AMONG THE STATISTICS OF THE DEAD AND DYING. AND FOR A MINORITY OF THEM, THE MESSAGE IS NOT BEING ABSORBED AT ALL. FOR THEM, IT IS "SEX AS USUAL", I'M AFRAID THAT THEY ARE GOING TO BE AMONG THOSE SAME STATISTICS. 6 BUT, OVERALL, THE EDUCATION PROGRAM HAS HAD A POSITIVE EFFECT. AND WE'RE RECEIVING NEW EVIDENCE ALL THE TIME THAT THERE IS A NEW AND HIGHER DEGREE OF RESPONSIBLE SEXUAL BEHAVIOR AMONG HOMOSEXUAL AND BISEXUAL MEN. AS I SAY, THAT HAS BEEN OUR EXPERIENCE WITH THIS SMALL AND RELATIVELY LITERATE COMMUNITY OF ADULT MEN. BEEN MOST ALSO BUT THE APPEARANCE OF THE ADULT HETEROSEXUAL VICTIM OF AIDS HAS A SOMBRE TURN OF EVENTS. THAT'S BEEN THE SIGNAL THAT ONE OF THE BASIC HUMAN BEHAVIORS--PRESENT IN THE HUMAN RACE GENERALLY--IS THE INVASION ROUTE OF THIS NEW KILLER DISEASE. NOW THE PROBLEM IS EVERYBODY'S SEXUAL BEHAVIOR...EVERYBODY'S ABILITY TO HANDLE THE PHENOMENON OF THEIR OWN HUMAN SEXUALITY. TO PARAPHRASE THAT GREAT LINE FROM "POGO", WE'VE LOOKED AT HUMAN SEXUALITY AND WE'VE DISCOVERED THAT "THE ENEMY IS US". SURVEYS HERE AND THERE INDICATE A MARKED SWING AWAY FROM FREQUENT, CASUAL SEX WITH MANY DIFFERENT PARTNERS AND TOWARD LOW RISK SEXUAL' RELATIONS WITH ONE PARTNER...MONOGAMY. 7 THIS SHIFT IN BEHAVIOR--ALONG WITH OTHERS, TO BE SURE--WHICH.IS REFLECTED IN A DECLINE IN THE INCIDENCE OF CERTAIN SEXUALLY TRANSMITTED DISEASES IN HOMOSEXUAL MEN MUST, OVER TIME, kLS0 OCCUR IN HETERDSEXUAL MEN AND WOMEN. WHAT MUST BE LEARNED OR RE-LEARNED--AND WHAT WE NEED TO REINFORCE - AMONG THE POPULATION IN GENERAL--IS THAT THERE'S MUCH MORE TO HUMAN RELATIONSHIPS THAT JUST "GOOD SEX". SEXUALITY IS JUST ONE ASPECT OF HUMAN RELATIONSHIPS. IT'S SOMETHING...BUT IT'S NOT EVERYTHING. BUT IF YOU BELIEVE OTHERWISE, THEN YOU OUGHT TO PREPARE YOURSELF FOR THE WORST, BECAUSE THE MOST DEVASTATING, FATAL DISEASE IN RECENT TIMES--AIDS--IS NOW BEING TRANSMITTED FROM ONE PERSON TO ANOTHER MAINLY THROUGH SEX . ..THAT IS, VAGINAL INTERCOURSE AS WELL AS ANAL INTERCOURSE. THIS IS EXTREMELY IMPORTANT INFORMATION FOR YOUNG PEOPLE, NH0 ARE ENTERING A PERIOD IN THEIR LIVES MARKED BY GREAT CURIOSITY AND SOME EXPERIMENTATION. THE STD'S - GONNORRHEA. SYPHILIS AND CHLAMIDIA ARE ON THE RISE IN YOUNG PEOPLE AND WE HAVE A MEASURE OF THEIR SEXUAL ACTIVITY IN THE 1,000,000 UNPLANNED PREGNANCIES IN TEENAGERS LAST YEAR. 8 AND, IN THE PAST, IF ANY OF THEM HAD A MISADVENTURE ALONG THE WAY-- SHORT OF PREGNANCY ITSELF--WE HAD A NUMBER OF ANTIBIOTIC THERAPIES TO BRING THEM BACK TO FULL HEALTH. BUT, A MISADVENTURE THAT PRODUCES AN AIDS INFECTION IS BEYOND THE CONTROL OF MODERN MEDICINE. WE HAVE NO VACCINE TO STOP IT. ..AND WE IjON'T HAVE ONE FOR MANY YEARS. WE HAVE NO MIRACLE DRUGS...AND NONE IS ON THE HORIZON. RIGHT NOW, THE VERY BEST WE CAN HOPE FOR IS THAT PEOPLE WHO ARE-- OR ARE BECOMING--SEXUALLY ACTIVE WILL HAVE A HEIGHTENED AWARENESS OF WHO THEY ARE..: HOW THEY CARE ABOUT THEMSELVES...AND HOW THEY CARE ABOUT OTHERS. YOU CAN ILLUSTRATE THIS BY HAVING CHARACTERS TALK OPENLY ABOUT SEX. LET ME GIVE YOU AN EXAMPLE. IN THE ATTEMPT TO GET THE AIDS PREVENTION MESSAGE ACROSS WE FACE WHAT I CALL "CONDOMANIA". YOU HAVE THE ABILITY TO MAKE CONDOMS A PART OF NORMAL SEXUAL ACTIVITY--AID TO DO IT IN GOOD TASTE. 9 `"SEXUALITY" IN THIS "AGE OF AIDS" CAN BE BOTH LIFE-GIVING..,AND DEATH-GIVING. BUT WE MUST "CHOOSE LIFE". AND I WOULD ARGUE THAT "LIFE" IS MORE LIKELY TO BE FOUND IN AN EQUITABLE RELATIONSHIP BETWEEN TWQ' PEOPLE WHO ARE MUTUALLY RESPECTFUL AND THOUGHTFUL...LOVING AND CARING. IN SUCH RELATIONSHIPS THERE MOST DEFINITELY WILL BE SEX. BUT IT IS SEX WITHOUT EXPLOITATION. IT'S SEX WITHOUT FEAR AND DOMINATION. IT'S SEX WITHOUT SYPHILIS, GONNORRHEA AND GUILT. AND IT'S SEX WITHOUT AIDS. I'M TELLING YOU ALL THIS IN MY LANGUAGE. BUT I KNOW YOU CAN DO BETTER THAT...BECAUSE YOU ALREADY HAVE. I'VE SEEN THOUGHTFUL, CARING RELATIONSHIPS BUILT RIGHT INTO SHOWS LIKE THE CROSBY SHOW, CAGNEY AND LACEY AND THE GOLDEN GIRLS, AND THEY'RE IN FILMS LIKE ROXANNE, LA BAMBA AND THE LIVING DAYLIGHTS. 10 AND I'M TOLD THAT THESE PICTURES ARE ALSO "DOING GOOD BUSINESS", AS THEY SAY IN YOUR INDUSTRY. APPARENTLY THE PUBLIC--AND YOUNG PEOPLE IN PARTICULAR--ARE HAPPY TO RECEIVE.. .AND TO PAY FOR.. .THIS KIND OF RICHER AND MORE REALISTIC MESSAGE. ..A MESSAGE THAT, RIGHT NOWi !$ < OUR BEST AND ONLY PROTECTION AGAINST THE FATAL, SEXUALLY TRANSMITTED DISEASE OF AIDS. THIS IS THE AREA WHERE YOU SHINE. YOU BRING INTO OUR LIVING ROOMS AND THEATERS CHARACTERS THAT PROVIDE ROLE MODELS FOR OUR CHILDREN. CHARACTERS THAT DEMONSTRATE THE KIND OF SEXUAL RESPONSIBILITY, RESPECT FOR SELF AND OTHERS THAT WILL STOP AIDS AND OTHER STD'S, UNWANTED PREGNANCIES AND PRODUCE A GENERATION OF WELL-ADJUSTED ADULTS. ALTHOUGH IT SEEMS UNLIKELY THAT THERE WILL BE AN EXPLOSIVE EPIDEMIC IN THE HETEROSEXUAL POPULATION, AS THERE WAS AMONG HOMOSEXUAL AND BI-SEXUAL MEN, THAT DOES NOT REDUCE THE INDIVIDUAL RISK TO THOSE WHO PRACTICE HIGH RISK SEXUAL BEHAVIOR. NOW LET ME TURN FROM THIS ISSUE OF HUMAN SEXUALITY TO ANOTHER ISSUE THAT'S EVERY BIT AS COMPLEX AS SEX AND IT, ALSO, IS PART AND PARCEL OF OUR NATIONAL TRAUMA OVER AIDS. THE ISSUE IS RACE. 11 OF ALL THE PERSONS WITH AIDS SO FAR SINCE 1981, 25 PERCENT HAVE BEEN BLACK... IN OTHER WORDS, BLACKS APPEAR TWICE AS OFTEN IN THE, AIDS STATISTICS AS THEY DO IN THE U.S. POPULATION IN GENERAL. AMONG ADULT HETEROSEXUAL MALES WITH AIDS. 48 PERCENT ARE BLACK. OF THE WOMEN ONLY WHO'VE HAD AIDS, 52 PERCENT HAVE BEEN BLACK... 14 TIMES THE INCIDENCE RATE AMONG WHITE WOMEN. AMONG BABIES BORN WITH AIDS, 81 PERCENT HAVE BEEN BLACK. WHEN WE TALK ABOUT BABIES I MUST DIGRESS A MOMENT. AS A PEDIATRIC SURGEON FOR OVER THRITY FIVE YEARS BABIES ARE MY LIFE. I URGE ANY WOMEN CONSIDERING A PREGNANCY TO BE TESTED FOR HIV INFECTION IF THERE IS ANY CHANCE SHE HAS BEEN EXPOSED. THERE IS NO SADDER PLIGHT THAN THAT OF THE BABY WITH AIDS. THE AIDS STATISTICS ARE PROPORTIONATELY ALMOST AS BAD FOR HISPANICS, ALSO. BUT THE GREATEST HUMAN CATASTOPHE RIGHT NOW SEEMS TO BE OCCURRING AMONG BLACK AMERICANS. THE REASON IS SIMPLE ENOUGH: THE SECOND MOST COMMON WAY TO BECOME INFECTED WITH AIDS IS TO SHARE A NEEDLE WITH A DRUG ADDICT WHO HAS AIDS. 12 AND DRUG ADDICTION--AND NEEDLE-SHARING--IS ALREADY AT EPIDEMIC RATES IN CITIES AND NEIGHBORHOODS WITH HIGH CONCENTRATIONS OF BLACKS. THAT ADDICTION IS RESPONSIBLE FOR MURDER, SUICIDE, AND A RANGE OF DISEASES. CLEAN NEEDLES WILL NOT STOP THE SEQUELLAE OF ADDICTION, MURDERS, SUICIDES AND A RANGE OF DISEASES. BUT THEY MIGHT AT LEAST CONTAIN THE SPREAD OF AIDS. THIS POINT COULD BE WELL MADE IN CRIME AND DETECTIVE STORIES THAT DEPICT DRUG USE. A NUMBER OF US IN THE PUBLIC HEALTH SERVICE HAVE MET WITH MANY LEADERS OF THE BLACK AND HISPANIC COMMUNITIES. WE HOPE TO PUT FORWARD SOME REALISTIC AND PRACTICAL PLANS TO TURN THIS SITUATION AROUND. MEANWHILE, HOWEVER, THE PROBLEM GROWS DAY BY DAY. I'M BRINGING THIS TO YOUR ATTENTION BECAUSE THE ELECTRONIC MEDIA--TELEVISION AND RADIO--AND FILMS ARE THE MOST POTENT COMMUNICATORS WE HAVE TODAY FOR REACHING AMERICANS. BUT I WOULD ONLY ASK NOW: HAVE YOU REACHED THEM ALL, ESPECIALLY THE COUNTRY'S HIGHLY VULNERABLE MINORITIES? I THINK BOTH OF US--YOU IN THE COMMUNICATIONS FIELD AND I IN THE PUBLIC HEALTH--HAVE COME UP SHORT. 13 I'M AFRAID WE CONTINUE TO GO BACK TO THE SAME LOW-RISK WHITE, MIDDLE-CLASS AND PREDOMINATELY SUBURBAN AUDIENCE WITH OUR AIDS-PREVENTION MESSAGE. AND THERE'S NOTHING INHERENTLY WRONG WITH THAT; THEY'RE LOW-RISK NOW AND WE WANT THEM TO STAY THAT WAY. BUT WE SHOULD ALSO BE REACHING ANOTHER POPULATION GROUP THAT IS AT A VERY HIGH-RISK; INNER-CITY BLACKS AND HISPANICS. AND WE NEED TO DO THAT SOON. I'M OPTIMISTIC ABOUT OUR ABILITY TO GRADUALLY CLOSE DOWN THE SPREAD OF THE AIDS VIRUS IN THIS COUNTRY. ONCE PEOPLE ARE GIVEN THE HARD FACTS ABOUT THIS DISEASE, I THINK THEY WILL THEN MAKE THE CORRECT DECISIONS ABOUT THEIR BEHAVIOR. BUT SEVERAL MILLION AMERICANS--BLACK AND HISPANIC MINORITIES TRAPPED IN THE INNER-CITY AND SURROUNDED BY DRUGS--MAY NOT BE GETTING OUR MESSAGES AT ALL. FOR THEM, IT CAN BE A MATTER OF LIFE OR DEATH. AS AN INDUSTRY YOU HAVE OVER THE YEARS EXPOSED THE BIGOTRY THAT WE ARE UNFORTUNATELY CAPABLE OF AND HELPED US RISE ABOVE IT. I ASK YOU TO CONSIDER THE PLIGHT OF THE LITTLE RAY BROTHERS AND THEIR FAMILY IN ARCADIA, FLORIDA. `DENIED ACCESS TO PUBLIC EDUCATION, SHUNNED, THEIR HOME BURNED TO THE GROUND. I CAN ASSURE YOU I KNOW OF MANY OTHER CASES THAT DIDN'T 14 MAKE THE PAPERS. PLEASE GET THE MESSAGE OUT "YOU CAN'T CATCH AIDS BY CASUAL CONTACT" HELP AMERICA GAIN ITS SENSES, FIND ITS HEART AND REGAIN ITS SOUL. AND I POSE MY QUESTIONS TO YOU TODAY. HOW CAN WE GET THROUGH THIS TIME OF PERSONAL TRAGEDY AND SOCIAL CONFUSION? WHAT DO AMERICANS NEED TO KNOW--OR NEED TO RE-LEARN ABOUT THEMSELVES-- IN ORDER TO GET THROUGH THIS PERIOD AND REMAIN THE DECENT AND COURAGEOUS PEOPLE THEY TRULY ARE? I BEGAN MY REMARKS TODAY BY CONGRATULATING YOU AND YOUR INDUSTRY ON THE ROLE YOU HAVE PLAYED ALREADY IN GETTING AMERICANS TO UNDERSTAND WHAT AIDS IS--AS:MUCH OR AS LITTLE AS WE KNOW ABOUT IT--AND YOU'VE HELPED EXPLAIN HOW THE VIRUS IS SPREAD AND TOUCHED US WITH THE HUMAN DIMENSION OF THE PROBLEM. THAT'S VERY GOOD. BUT IT LOOKS LIKE THE JOB IS ONLY HALF-DONE. NOW, WE NEED TO FOCUS ON PERSONAL--AND NATIONAL--STRENGTHS AND BEHAVIORS. 15 SO, I LOOK FORWARD TO THE DAY, A FEW YEARS HENCE, WHEN I MIGHT RETURN AND THANK YOU ONCE AGAIN. BUT THEN IT WILL BE FOR THE JOB YOU HAVE DONE IN ILLUMINATING THE FULL EXPERIENCE OF HUMAN SEXUALITY AND HUMAN RELATIONSHIPS AND FOR YOUR ROLE IN HELPING TO RE-COMMIT OUR SINGLE AND SINGULAR NATION TO THE PRINCIPLES OF COMPASSION AND JUSTICE IN THE FACE OF A DEADLY EPIDEMIC. YOUR TELEVISION PROGRAMMING, SERIES, MOVIES OF THE WEEK AND DRAMATIC PRODUCTIONS CAN RESTORE THE SEXUAL.AND MORAL HEALTH OF THIS NATION. NOT AN EASY TASK BUT IT'S ALWAYS THE CHALLENGE TO THE HUMAN SPIRIT THAT KEEPS US GOING. PLEASE JOIN WITH ME FOR THE HEALTH OF THIS GREAT NATION. THANK YOU.